PROGRAM MAY NO LONGER BE AVAILABLE: Verzenio Continuous Care Bridge Program

Funded

About

The Verzenio Continuous Care Bridge Program is designed to assist eligible patients by providing a 28-day supply of Verzenio at no charge. This program aims to ensure that patients who are new to Verzenio and facing insurance coverage delays can access their medication promptly. By participating in the Verzenio Continuous Care Bridge Program, patients benefit from continued drug support during uncertain insurance conditions.

Insurance requirements: Commercially insured

Enrollment Forms

Enrollment Form

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Must be 18 years of age or older

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: No

•Activation Required: No

Program Details

•Program provides a 28day (one cycle) supply of Verzenio at no charge for eligible, insured patients who are:

•1) new to Verzenio,

•2) experiencing a minimum 5businessday delay in insurance coverage after the insurance provider has all necessary information to make a determination,

•3) prescribed Verzenio for an FDAapproved indication, and

•4) enrolled in the Verzenio Continuous Care program

•May not be combined with any other offer

•Not available to patients whose insurers have made a final determination to deny the patient coverage for Verzenio

•If a nonfinal denial is received after the 5 business days have passed and appeal rights are being pursued, or if there is a persistent coverage delay, the patient, under appropriate circumstances, may be eligible for a 28day (one cycle) refill of Verzenio

•Benefits provided under the program are not transferable

•Requires valid patient HIPAA authorization

•Offer good for up to 12 months from patient qualification into the program

•Patient and HCP must complete enrollment form; HCP must complete the entire form and submit pages 13 to Verzenio Continuous Care™ via fax at 18555455957

•For assistance, call 1844VERZENIO (18448379364), MondayFriday 8am – 10pm ET

Enrollment Forms

Enrollment Form

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